Richard Nixon's Left Knee and Its Impact on American History

Richard Nixon injured his left knee in a limousine door while campaigning in North Carolina in 1960, resulting in septic arthritis that required a multi-day admission to Walter Reed Hospital. Still ill for the first presidential debate that fall, Nixon lost the contest based more on his appearance than his performance. Partly as a result of this debate, he was defeated by John F. Kennedy in the general election. Because of his leg wound, Nixon developed chronic DVTs in that limb, including a severe thrombus in 1974 that embolized to his lung, required surgery, and prevented him from testifying at the Watergate Trial. Episodes like this one highlight the value of studying the health of famous figures, where even the most minor injuries have the potential to influence world history.

'Through and Through' History: The Management of Gunshot Wounds From the 14th Century to the Present

Gun violence killed over 46,000 Americans in 2021; almost 120,000 suffered gunshot wounds. This epidemic has attracted national attention and increasing concern from medical and surgical organizations, as evident in this special issue. 'Through and Through History' explores the surgical management of gunshot wounds from their earliest appearance in 14th-century Europe to the present. Interweaving the civilian and military experience, it details not only the evolution of care directly applied to patients but also the social, political, and scientific milieu that shaped decisions made and actions performed both in and out of the operating room. The article describes how surgeons have pushed the boundaries of medicine and science in each era, developing new therapies for their patients, a historical trend that persists today when such care has the potential to save tens of thousands of lives each year.

Anesthesia in the Korean War

Relying on original, primary source documentation from the National Archives, we describe the practice of anesthesia in mobile army surgical hospital (MASH) units and the 171st Evacuation Hospital during the latter part of the Korean War in 1953. Values were scaled and reported as percentages. These Essential Technical Medical Data Sheets reveal a surprising proportion (12.9%) of men received spinal anesthetics, despite official recommendations to the contrary. Still, the majority (69.2%) of the wounded underwent general anesthesia, most commonly through a mixture of thiopental and nitrous oxide. Despite data from World War II demonstrating the advantages of endotracheal intubation in these patients, few patients (20.6%) were intubated. Six percent benefited from the new curare-based drugs. This is the first English-language article that describes the practice of anesthesia during the Korean War. Utilizing primary source documentation, we found that general anesthesia was the most common type utilized. Newer techniques were not as commonly adopted, despite official recommendations and data from the time. The care provided closely resembled that delivered in the Second World War but inspired a series of technological and pedagogical reforms through the 1950s to improve military anesthesia for the next conflict.

Medicine and History: a Surgical Model for National Integration

Historians and physicians have struggled to incorporate history into American medical education for over a century. Most efforts focus on local initiatives targeting a narrow audience. We describe a novel method involving the American College of Surgeons, a national organization with tens of thousands of members. Capitalizing on its infrastructure and influence over the field, we have implemented a variety of ventures that include panel sessions at meetings, poster competitions, travel grants, themed breakfasts, online communities, and other such projects. This programming has reached thousands of participants, ranging from pre-medical students to retired physicians, and it has increased both the exposure to and production of surgical history. Our article describes the process of establishing this nationally coordinated enterprise in the hopes that other medical specialties can emulate it and further the study of and appreciation for medical history.

History of Medicine in the Clerkships: A Novel Model for Integrating Medicine and History

The history of medicine has only unevenly been integrated into medical education. Previous attempts to incorporate the subject have focused either on the first year, with its already over-subscribed curriculum, or the fourth year in the form of electives that reach a small minority of students. Duke University provides an alternative model for other universities to consider. At our institution we have overcome many of the curricular limitations by including history during the mandatory third year clerkships. Reaching 100% of the medical school class, these sessions align with clinical disciplines, providing students a longitudinal perspective on what they are seeing and doing on the hospital wards. They are taught in conjunction with a medical history librarian and rely heavily on the utilization and interpretation of physical artifacts and archival manuscripts. The surgery, obstetrics/gynecology, and pediatrics rotations now feature successful and popular history of medicine sessions. Describing our lesson plans and featuring a list of both physical and online resources, we provide a model others can implement to increase the use, the framing, and the accessibility of history in their medical schools.

Harry Truman's Complicated Cholecystectomy

MINI-ABSTRACT

Harry S. Truman, the 33rd President of the United States, developed right-sided abdominal pain the year after he left office. Misdiagnosed with appendicitis, Truman underwent an appendectomy before a cholecystectomy treated the underlying cholecystitis. This error was concealed at the time from the American people. His postoperative course was closely followed by Americans through newspapers and was complicated by a bout of Clostridium difficile colitis. Truman survived this episode to die of heart failure decades later.

Stricken Before Election: Presidential Health Crises From 1880 to 2020

Between 1880 and today, 6 presidents have suffered major health crises just before their reelection campaigns. Ranging from Chester Arthur's development of Bright's Disease to Donald Trump contracting COVID-19, diseases and their treatments varied considerably. More interesting than the medical management, however, is the political maneuvering around each and the extraordinary lengths Presidents went to demonstrate their health to the American people. This article reviews these episodes, comparing and contrasting how each administration handled their crisis and what effect it had on the ensuing election-and thus the history of the United States.

P057 Virus aerosol propagation by CPAP is proportional to mask leak and can be prevented by use of a hood and air filtration system

Introduction

Nosocomial transmission of SARS-CoV-2 has caused significant morbidity/mortality in the COVID-19 pandemic. Because patients auto-emit aerosols containing viable virus, these aerosols can be further propagated when patients undergo certain treatments including continuous positive airway pressure (PAP) therapy. This study aimed to assess the degree of viable virus propagated from mask leak in a PAP circuit.

Methods

Bacteriophage PhiX174 (108copies/mL) was nebulised into a custom PAP circuit. Mask leak was systematically varied to 0, 7, 21, 28 and 42 L/min at the mask interface. Plates containing Escherichia coli assessed the degree of viable virus settling on surfaces around the room. In order to contain virus spread a ventilated headboard and high efficiency particulate air (HEPA) filter was tested.

Results

Increasing mask leak was associated with virus contamination in a dose response manner (χ2= 58.24, df=4, p<0.001). Clinically relevant levels of leak (≥21 L/min) were associated with virus counts equivalent to using PAP with a standard vented mask. Viable viruses were recorded on all plates (up to 3.86m from source). A plastic hood with HEPA filtration significantly reduced viable viruses on all plates. HEPA exchange rates of 170 and 470m3/hr eradicated all evidence of virus contamination.

Discussion

Mask leak from PAP circuits may be a major source of environmental contamination and nosocomial spread of infectious respiratory diseases. Subclinical levels of leak should be treated as an infectious risk. Cheap and low-cost patient hoods with HEPA filtration are an effective countermeasure.

Bottoms Up: A History of Rectal Nutrition From 1870 to 1920

From the 1870s through the early 20th century, physicians frequently relied upon nutritive enemata to succor patients suffering from bowel obstructions and other disorders of the gastrointestinal system. Far from extraordinary or outlandish, this therapy was used on paupers and presidents alike, including on Garfield and McKinley after their assassination attempts. The medical milieu of the late 19th century provided particularly promising circumstances for its practice, with the rise of allopathic medicine generally-and surgery especially-coinciding with flourishing research on the physiology of nutrition. Although ongoing discussions debated the merits of different methods and various ingredients, few in the United States or Europe doubted the efficacy of rectal alimentation. However, in the early 20th century, new studies utilizing biochemistry demonstrated the inability of such instillations to provide significant calories or protein, and the intervention fell from favor. Proctoclysis-or rectal hydration-remained standard of care for the next 20 years, strongly supported by John B. Murphy and other surgeons. Ultimately, intravenous hydration and, much later, total parenteral nutrition replaced the rectal route.

We Are What We Write: 133 Years of History in 4 Surgical Journals

The profession of surgery has long purported to value its history. This study evaluates that interest by calculating the percent of historical articles in 4 major general surgery journals from 1885 to 2018 (Annals of Surgery; Surgery, Gynecology, and Obstetrics; American Journal of Surgery; and Archives of Surgery). Of all articles published over the last 133 years, 1.65% focused on history, although this percentage fluctuated between 0% and 4.77%. A peak in the 1920s likely both represents and buttresses a national movement to elevate and professionalize the field of surgery. A plurality of the articles were biographical. The proportion of history articles in these journals has been declining of late due to reasons such as the proliferation of periodicals and impact factor considerations. The new Annals of Surgery-Open promises an ideal forum to publish this work, celebrate our heritage, and study the history of who we are as surgeons.

The Oswald injury

On November 22, 1963, John F. Kennedy, the 35th president of the United States, was assassinated in Dallas, Texas. John B. Connally, the Governor of Texas, simultaneously was injured in the shooting. Both Kennedy and Connally were transported to and cared for at the Parkland Memorial Hospital. Within 3 hours, the accused assassin, Lee Harvey Oswald, was arrested and taken to the Dallas City Jail in the Downtown Municipal Building. When the authorities were transferring Oswald from the City to the County Jail at midday on November 24, Jack Ruby shot him as the event was televised and broadcast live to the nation. Oswald was rushed to Parkland Memorial Hospital where he was operated on by the same surgeons who had attended Kennedy and Connally 2 days previously. This article reviews the operative treatment that Oswald received before discussing the state of abdominal vascular trauma in the 1960s.

Biomedical Research in Times of Emergency: Lessons From History

Coronavirus disease 2019 (COVID-19) has sickened millions, killed hundreds of thousands, and utterly disrupted the daily lives of billions of people around the world. In an effort to ameliorate this devastation, the biomedical research complex has allocated billions of dollars and scientists have initiated hundreds of clinical trials in an expedited effort to understand, prevent, and treat this disease. National emergencies can stimulate significant investment of financial, physical, and intellectual resources that catalyze impressive scientific accomplishments, as evident with the Manhattan Project, penicillin, and the polio vaccines in the 20th century. However, pressurized research has also led to false promises, disastrous consequences, and breaches in ethics. Antiserum in the 1918 flu epidemic, contaminated yellow fever vaccines in World War II, and unethical human experimentation with mustard gas offer just a few cautionary exemplars. It is critical to continue biomedical research efforts to address this pandemic, and it is appropriate that they receive priority in both attention and funding. But history also demonstrates the importance of treating early results-such as those associated with hydroxychloroquine-with caution as we only begin to understand the biology, epidemiology, and potential target points of COVID-19.

Surgeons, plague, and leadership: A historical mantle to carry forward

•Surgeons have a long tradition of leading research into pandemics. •Examples include Guy de Chauliac, James Lind, John Snow, John Hunter, Walter Reed. •We should leverage this history to lead efforts fighting COVID-19.

The History of Wound Healing

Since the dawn of humanity, wounds have afflicted humans, and healers have held responsibility for treating them. This article tracks the evolution of wound care from antiquity to the present, highlighting the roles of surgeons, scientists, culture, and society in the ever-changing management of traumatic and iatrogenic injuries.

Robotic Inguinal Hernia Repair (TAPP) First Experience with the New Senhance Robotic System

INTRODUCTION

This retrospective study was performed to evaluate the safety and feasibility of the new Senhance Robotic System (TransEnterix Inc., Morrisville, North Carolina) for inguinal hernia repairs using the transabdominal preperitoneal approach.

MATERIALS AND METHODS

From March to September 2017, 76 inguinal hernia repairs in 64 patients were performed using the Senhance Robotic System. Patients were between 18 and 90 years of age, eligible for a laparoscopic procedure with general anesthesia, had no life-threatening disease with a life expectancy of less than 12 months, and a body mass index (BMI) < 35. A retrospective chart review was performed for a variety of pre-, peri-, and postoperative data including, but not limited to, patient demographics, hernia characteristics, and intraoperative and postoperative complications.

RESULTS

Fifty-four male and 10 female patients were included in the study. Median age was 56.5 years (range 22-86 years), and median BMI was 25.9 kg/m2 (range 19.5-31.8 kg/m2). Median docking time was seven minutes (range 2-21 minutes), and median operative time was 48 minutes (range 18-142 minutes). Two cases were converted to standard laparoscopic surgery due to robot malfunction and abdominal wall bleeding, respectively. Median length of stay was one day.

CONCLUSION

We report the first series of laparoscopic inguinal hernia repairs using the new Senhance Robotic System. Compared to conventional laparoscopic transabdominal preperitoneal (TAPP) hernia repairs, there was no significant difference in operative time or perioperative complications. Additionally, there was no significant learning curve detected due to its intuitive applicability. Therefore, the Senhance Robotic System promises broad applicability across a range of laparoscopic general surgical operations.

The Role of the American Board of Surgery in the Development of Surgical Residencies in Post–World War II America

The creation of Boards fundamentally altered the American medical landscape and transformed the process of educating physicians. The American Board of Surgery, founded in 1937, epitomized this role. It established expectations, implemented an inspection system to enforce those standards, and ultimately collaborated with other professional organizations to create the Residency Review Committee that endures today. Using surgery as an example, we show how the appeal of board certification imbued Boards with the power and authority to reshape graduate medical education in their image in post–World War II America.

The Role of the American Board of Surgery in the Development of Surgical Residencies in Post-World War II America

The creation of Boards fundamentally altered the American medical landscape and transformed the process of educating physicians. The American Board of Surgery, founded in 1937, epitomized this role. It established expectations, implemented an inspection system to enforce those standards, and ultimately collaborated with other professional organizations to create the Residency Review Committee that endures today. Using surgery as an example, we show how the appeal of board certification imbued Boards with the power and authority to reshape graduate medical education in their image in post-World War II America.

The Education of American Surgeons and the Rise of Surgical Residencies, 1930-1960

In the first half of the twentieth century, the training of American surgeons changed from an idiosyncratic, often isolated venture to a standardized, regulated, and mandated regimen in the form of the surgical residency. Over the three critical decades between 1930 and 1960, these residencies developed from an extraordinary, unique opportunity for a few leading practitioners to a widespread, uniform requirement. This article explores the transformation of surgical education in the United States, focusing on the standardization and dissemination of residencies during this key period. Utilizing the archives of professional organizations, it shows how surgical societies initiated and forced reform in the 1930s. It demonstrates the seminal and early role taken by the federal government in the expansion of surgical residencies through incentivized policies and, especially, the growth of the Veterans Administration health system after World War II. Finally, an examination of intra-professional debates over this process illustrates both the deeper struggles to control the nature of surgical training and the importance of residency education in defining the midcentury American surgeon.

Vertebroplasty and Kyphoplasty for Osteoporotic Vertebral Fractures: What Are the Latest Data?

Osteoporotic vertebral compression fractures frequently result in significant morbidity and health care resource use. For patients with severe and disabling pain, vertebral augmentation (vertebroplasty and kyphoplasty) is often considered. Although vertebroplasty was introduced >30 years ago, there are conflicting opinions regarding the role of these procedures in the treatment of osteoporotic vertebral compression fractures. This review article updates clinicians on the published prospective randomized controlled data, including the most recent positive trials that followed initial negative trials in 2009. Analysis of multiple national claim datasets has also provided further insight into the utility of these procedures. Finally, we considered the recent recommendations of national organizations and medical societies that advise on the use of vertebral augmentation procedures for osteoporotic vertebral compression fractures.